Turkish Archives of Otorhinolaryngology Turk Arch Otorhinolaryngol 2016; 54: 21-8 21 Türk Otorinolarengoloji Arşivi

Prevalence of Allergic Rhinitis in Children in the Province of the Region of

Hatice Bengü Çobanoğlu1, Abdülcemal Ümit Işık2, Murat Topbaş3, Ahmet Ural2 1Department of Otorhinolaryngology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey 2Department of Otorhinolaryngology, Karadeniz Technical University School of Medicine, Trabzon, Turkey Original Investigation 3Department of Public Health, Karadeniz Technical University School of Medicine, Trabzon, Turkey

Abstract Objective: We aimed to determine the prevalence Results: The prevalance of allergic rhinitis in children of allergic rhinitis in children aged 12-15 years who between 12 and 15 years age was found to be 14.5% in lived in the Trabzon Province, specify possible risk Trabzon. Female gender was found to be a relative a factors, and compare the data obtained with those risk factor for allergic rhinitis (p=0.015). The prevalence of the other studies conducted in our country and in of allergic rhinitis in children whose both parents were smoking was significantly higher than that in children other countries. whose only one parent was smoking or both parents Methods: First, 1372 students from nine primary were nonsmokers (p=0.0024). In addition, living in an schools determined according to the recommendations apartment flat (p=0.015) and owing pets (p=0.04) were of Department of Public Health and approval of The detected to be other risk factors for allergic rhinitis. Provincial Directorate of Health were screened in their Conclusion: According to our investigations, this is schools with questionnaire forms. Second, students the first prevalence study in Trabzon, which is the providing the response “yes” to the first and/or second largest settlement in the Eastern . questions in the questionnaire forms were considered The prevalence of allergic rhinitis in children was as possible allergic rhinitis patients and invited to our found to be 14.5%. Female gender, smoking habits of clinic. Then, 246 students were subjected to a skin prick the parents, owing pets, and living in an apartment flat are risk factors for allergic rhinitis. test. Data were collected with the evalution of ques- tionnaire and skin prick test results together. Keywords: Allergic rhinitis, prevalence, pediatric

Introduction and Provincial Directorate of Health in Trabzon Allergic rhinitis is a globally observed disease that city center to specify the possible risk factors and can severely affect the quality of life. It includes to compare the data obtained with those of other an intermittent type that is observed in the pol- studies performed in other cities of Turkey as well len season and a persistent type that continues as other countries. throughout the year. Allergens vary according to the climates and countries (1). Diagnosis can be This study was performed to determine the preva- performed with a good medical history, physical lence of allergic rhinitis in students aged 12–15 years examination, and skin test. The complaints of pa- old in the Trabzon city center. tients can be minimized by protection from aller- gens and by appropriate medical treatment (2). Methods Nine primary schools were specified at the city In recent years, an increase in allergic diseases according to the recommendations of the Pro- This study was presented at the 32nd National Otorhinology Head and Neck preoccupies the role of environmental factors. vincial Directorate of Health and the approval of Surgery Congress as an oral presentation, 27-31 October 2010, , Turkey. However, among thousands of environmental the school managements in 2010. The study was Address for Correspondence: factors, the exact factor remains unknown. approved by the Karadeniz Technical University Hatice Bengü Çobanoğlu, Findings regarding the role of smoking, exhaust Ethics Committee (file no: 2009/36). E-mail: [email protected] Received Date: 23.06.2015 gas, air pollution, and living in hygienic conditions Accepted Date: 07.02.2016 have been reported (3). Because no similar study Based on the population of the city where this © Copyright 2016 by Official Journal of the Turkish has been performed in our region so far, we study was conducted, approximately 1300 students Society of Otorhinolaryngology and Head and Neck Surgery Available online at planned to screen 1372 students aged 12–15 years were recommended for screening in order to meet www.turkarchotorhinolaryngol.org from nine schools. The schools were determined the statistical sufficiency required by the Depart- DOI: 10.5152/tao.2016.1089 together with the Department of Public Health ment of Public Health. 22 Çobanoğlu et al. Allergic Rhinitis Prevalence in Trabzon Turk Arch Otorhinolaryngol 2016; 54: 21-8

The Department of Public Health suggested screening of the Results 12–15-year-old age group in the consideration of reliability of The questionnaire survey was provided to 1372 students (female, the responses to the questionnaire items and easier cooperation n=712, 52%; male, n=658, 48%), and two students were exclud- during prick tests. Our study consisted of two stages. In the first ed from the study because of psoriasis. Nearly half (145/291, stage, students were scanned at their schools using the “Ques- 49.8%) of the students had marked the “yes” option for the first tionnaire method.” The questionnaire was prepared by taking the or second question in the questionnaire. In other words, these questions on the official site of the European Allergic Rhinitis patients had allergic rhinitis before or they were sneezing, had and Asthma Committee (ECRHS) as the base (4). Question- nasal drainage, or had nasal obstruction and indicated that they naire items included house environments, bedrooms, pet habits, had used drugs before for complaints of sneezing, nasal drain- status of allergic complaints according to the seasons, age of the age, and nasal obstruction. mother, and smoking status of the parents (Figure 1). The students (n=291) who had marked the “yes” option for the A total of 1372 students at the city were given this survey. Approvals first or second question were called to our clinic for the skin from the management of the primary schools were obtained, and prick test, and this test was performed for 246 of them. Some upon this approval, written consents of the families were also (n=192) of the students with positive prick test results were di- obtained before handing out the questionnaires to the students agnosed with allergic rhinitis. in their classrooms. Students responding “yes” to the first and/or second questions in the questionnaire were considered as potential When the findings of the skin prick test and questionnaire were allergic rhinitis patients and were invited to our clinic for a prick evaluated together, the prevalence of allergic rhinitis was found test. Before the prick test, consents of their families were obtained. to be 14.5%. Investigation of the other factors and statistical Information about antihistaminic or other drug usage, which could evaluation were performed in these patients (Table 1). degrade the test results of the questionnaire survey, was obtained, and the students were warned not to use any drugs before coming Allergy–Gender: Among the students who were accepted as to our clinic for the prick test. In this group, two students had having allergic rhinitis according to the evaluation of the re- psoriasis; therefore, the test could not be performed on them. The sponses to the questionnaire items and findings of the skin prick test was routinely performed using 24 standardized Alk- prick test, allergic rhinitis was found in 115 (16.8%) female and Albio (ALK; Berkshire, UK) Allergens. Allergens were applied 77 (12.1%) male students. It was observed that female gender to both arms and penetrated into the subcutaneous layers via a was a significant risk factor for the diagnosis of allergic rhinitis lancet. After waiting for 15 minutes, the allergens that induced (p=0.015). an induration with a diameter equal to or greater than that of the control allergen histamine were accepted as the specific allergen Allergy–Smoking Habits of the Parents: Parents of 616 stu- responsible for the development of allergic rhinitis. During the dents (46.7%) were nonsmokers. Fathers of 438 students 15-minute waiting period in our clinic, students were accompanied (33.2%) and mothers of 96 students (7.2%) were the only smok- by an attendant, and emergency kit and drugs were kept ready in ers in the family, while both parents of 169 (12.8%) students case of any possible anaphylaxis or allergic reaction. were smokers. The relationship between the smoking habits of the parents and allergy was also investigated. Allergic rhinitis Our study is summarized by a flow chart (Figure 2). With the was detected in 12.2% of the children whose parents were non- findings of the prick test and questionnaire, the correlations be- smokers. The rates of allergic rhinitis in children whose father, tween allergic rhinitis and factors such as smoking habits of the mother, or both parents were smokers were 15.5%, 13.5%, and parents, heating system in the house, room share in the house, 21.3%, respectively. The prevalence of allergic rhinitis in children seasonal variations in the symptoms of allergic rhinitis, type of whose mother and father were both smokers was significantly residence, owning pets, and age of the mother were determined. higher than that in children whose only one parent was a smok- er or both parents were nonsmokers (p=0.04). Statistical Analyses Data were analyzed using the Statistical Package for the Social Allergy–Heating Devices Used in the House: The students Sciences (SPSS) software program (version 12.0 for Windows) were using room heaters (n= 358: 26.1%), the central system (SPSS Inc.; Chicago, IL, USA). Data normality was assessed (n=486; 35.5%), wood heaters (n=23016.8%), coal burning stoves using the Kolmogorov–Smirnov test. Comparisons between (n=266: 19.4%), electrical heaters (n=41; 3%), or both electrical groups were performed using Student’s t test for normally dis- heaters and the central system (n=9). Accordingly, the frequency tributed data. Comparisons between groups for quantitative data of allergic rhinitis among the students using wood heaters or and prevalence of allergic rhinitis were performed using the Chi other heaters was 17.2% and 13.8%, respectively, without any square test. For risk factors associated with allergic rhinitis, anal- significant difference between groups (p=0.172). ysis was performed using logistic regression analysis, in which al- lergic rhinitis was taken as the dependent variable. Results were Allergy–Room Share in the House: The students (n=558) shown as the arithmetic mean±standard deviation (SD) for quan- stayed all alone in their private rooms or shared their rooms with titative data and as percentages for qualitative data. Odds ratio one (n=644), two (n=98), three (n=17), and four (n=5) people. (OR) [95% confidence interval (CI)] was used for logistic regres- The prevalence of allergic rhinitis among students who stayed sion analysis, and p<0.05 was considered as significant. alone or those who shared their rooms with one or more than Turk Arch Otorhinolaryngol 2016; 54: 21-8 Çobanoğlu et al. Allergic Rhinitis Prevalence in Trabzon 23

ALLERGIC RHINITIS QUESTIONNAIRE FORM

Name: ...... Surname: ......

Age: ...... Gender: ......

Address: ......

Tel: ...... Mark the options next to the questions below that suits to you 1. Did you have any allergic rhinitis or hay fever diagnosis before? Yes ( ) No ( ) 2. When you have no flu or cold, do you have any sneezing, nasal obstruction, or nasal drainage complaints? Yes ( ) No ( ) If you have responded “yes” to this question, continue to the third question; if you have responded “no,” continue to the seventh question. 3. In which season are your complaints such as out-of-flu sneezing, nasal obstruction, or rash more? Spring ( ) Summer ( ) Autumn ( ) Winter ( ) 4. Have you used any drugs for such complaints? Yes ( ) No ( ) 5. Did you have any rash, skin eruption, or eczema complaints? Yes ( ) No ( ) 6. Did you feel any respiratory disorder when you had any sneezing, nasal obstruction, or nasal drainage complaints? Yes ( ) No ( ) 7. How old was your mother when she was pregnant with you?

......

8. How many houses did you change in the last 5 years? None ( ) Once ( ) More than one ( ) 9. With how many people are you staying in your room at your house?

......

10. Your house is ______Flat ( ) House ( ) Old wooden house ( ) Chanty ( ) 11. With how many people are you staying in your house?

......

12. How do you get heat in your house? Room heater ( ) Central heating ( ) Wood Burner ( ) Coal burning stove ( ) Electrical heater ( ) 13. On which floor is your house located?

......

14. Does your mother or father smoke?

......

15. If you have smoking parents, please specify who is a smoker

......

16. Do you have a pet in your house? Cat ( ) Fish ( ) Dog ( ) Other ( ) Bird ( ) None ( )

Figure 1. Allergic rhinitis questionnaire form one person was 13.1% and 15.5%, respectively. The intergroup seasons, from the findings of the prick test, it was observed that difference was not found to be significant (p=0.214). the symptoms of the children who were allergic to the weed group, main tree group, and main prairie group were significant- Allergy–Seasonal Variations in Symptoms: The students com- ly higher in the spring season, according to their own informa- plained of allergic rhinitis symptoms for one (n=52), two (n=15), tion (according to the questionnaire answers) (p<0.001). or all four seasons (n=5). No significant difference was found between the seasonal differences and symptoms (p=0.112). Allergy–House Type Relationship: With regard to the type However, when we considered the allergens according to the of the house where the students were living, we observed that 24 Çobanoğlu et al. Allergic Rhinitis Prevalence in Trabzon Turk Arch Otorhinolaryngol 2016; 54: 21-8

1169 students lived in an apartment flat and 118 students lived in a private garden house. The incidence rate of allergic rhinitis 1372 Students among students living in an apartment flat was 15.4%, while that among the students living in a private garden house, wood- en house, or other types of houses was 8.4%. According to these 2 Students psoriaris results, living in an apartment flat is a risk factor for allergic rhinitis (p=0.015).

Called because of Eliminated in Allergy–Pet Feeding Relationship: When we looked at the re- the questionnare the questionnare sponses to the question “Do you have a pet at your house?,” we found that students had cats (n=18), dogs (35), pet birds (n=98), aquarium fish (n=202), and turtles (n=60); in total, 413 students had pets at their n-homes. The relationship of allergic rhinitis 291 people (21.2%) 1079 people (78.8%) with pet feeding in the house was considered; the prevalence of allergic rhinitis in the students having a pet in their house was found to be 16%, while that in students who had no pets 246 people in their house was found to be 13.8%. The prevalence of allergic 43 people (Absent) Prick applied rhinitis in students who fed cats and dogs at their houses, which were accepted as allergens other than fish, turtles, and birds, was found to be 17%. Depending on these numbers, owing pets was considered as a risk factor for allergic rhinitis (p=0.04). 19 (+) 54 (%) Correlation Between Allergy and Mother’s Age: When the responses to the question “How old was your mother when you were born?” were evaluated, the mean age of the mothers of the Allergic rhinitis allergy-negative students who had allergic rhinitis before was found to be 26.1±4.7 years and that of the mothers of the al- Figure 2. Flow chart of the study lergy-positive students was found to be 25.5±5.1 years, without significant difference between groups (p=0.163).

Table 1. Sociodemographic data Risk factors Students with allergic rhinitis p value Gender female 115 (16.8%) 0.015 male 77 (12.1%) Smoking habits of parents none 75 (12.2%) 0.0024 only mother 13 (13.5%) only father 68 (15.5%) both parents are smokers 36 (21.3%) Heating device used in the house floor heating 53 (15.3%) 0.172 central system 65 (13.7%) wood stove 24 (11.4%) coal stove 44 (17.2%) room heater (with electric) 6 (15.8%) Room sharing single 73 (13.1%) 0.214 sharing room with one or more people 119 (15.5%) House type apartment 180 (15.4%) 0.014 others 12 (8.4%) Owning pets none 126 (13.8%) 0.040 pet owner 66 (16%) owner of only cat/dog 9 (18%) Age of the mother at delivery average age of the mother in students with allergic rhinitis 25.5±5.1 0.163 average age of the mother in students with no allergic rhinitis 26.1±4.7 Turk Arch Otorhinolaryngol 2016; 54: 21-8 Çobanoğlu et al. Allergic Rhinitis Prevalence in Trabzon 25

The first study on children with allergic rhinitis in Turkey was Table 2. Prick test results conducted in between 1966 and 1967. While 23% of Weed allergy 48 students (25%) 1163 atopic children aged between 6 and 13 years had only per- Main tree group (pine, birch, hazelwood) 68 students (35%) sistent allergic rhinitis, the remaining 77% also had asthmatic bronchitis or atopic dermatitis (6). The prevalence studies on Main prairie group (dactylis, festuca, lolium, adults conducted in Şanlıurfa and reported the preva- phleum, phoa) 39 students (20.3%) lence of allergic rhinitis to be 2.9% and 14.5%, respectively (7, Main wheat group 1 student (0.5%) 8). However, based on the studies on the pediatric population in Fungi group 0 and , the prevalence of allergic rhinitis was Penicillin notatum 2 students (1%) found to be 37.7% and 7.9 %, respectively (9, 10). Candida albicans 1 student (0.5%) Studies on the prevalence of allergic rhinitis have generally been Silverbirch 1 student (0.5%) conducted by pediatric and otorhinolaryngology clinics, and Willow 2 students (1%) these studies have used two questionnaire types to date. While Ligustrum 2 students (1%) pediatrics departments have usually used the International Study Dermatophytes pteronyssinus 96 students (50%) of Asthma and Allergies in Childhood (ISAAC) questionnaire, the ECRHS questionnaire, which was easy to modify and apply Dermatophytes farinae 96 students (50%) to every age group, has been preferred more frequently in stud- Sambucus tree 2 students (1%) ies conducted by otorhinolaryngology clinics. The reason behind Pine tree 4 students (2.1%) this difference is that researches conducted by the pediatrics de- Poplar tree 3 students (1.6%) partments generally involved not only allergic rhinitis but also other allergic conditions such as asthma and childhood eczema Sweet spring grass 31 students (16.1%) (4). We used the ECRHS questionnaire in this study as well. Cat 4 students (2.1%) Dog 5 students (2.6%) In this study, the prevalence of “allergic rhinitis” was determined Corn 0 as 14.5% according to our questionnaire results. When we ex- amined the prevalence studies conducted all around the world, Hazelnut 1 student (0.5%) we found that Selnes et al. (11) reported the prevalence of al- Dead nettle 1 student (0.5%) lergic rhinitis to be 29.6% in 2005 in Norway among West- Cynodon dactylon 2 students (1%) ern European countries. In a study conducted by Bauchau and Durham (12) in six countries in 2004, the prevalence of allergic Allergy–Prick Test Results: Students who had responded “yes” rhinitis were reported to be 28.5% in Belgium, 24.5% in France, to the first and/or second question were called for the prick test. 20.6% in Germany, 16.9% in Italy, 21.5 % in Spain, and 26% The prick test was performed by the original 24-fold allergen in England. This prevalence study by Bauchau and Durham. extracts of Alk-Albio in 246 of 291 students who consented was conducted on adults, but there is no such extensive study in children. It is one of the most comprehensive studies in Europe. and came to our clinic. In 192 of them, positive (+) results were Accordingly, the prevalence of allergic rhinitis in our region was found in the prick test, and allergic rhinitis was diagnosed. Dis- comparable to that reported in other studies conducted in Tur- tribution according to the allergenic parameters observed in the key and but lower than that detected in Western Europe. prick test is shown in Table 2. Some studies have revealed that male gender is a relative risk factor According to these results, in children who had allergic rhinitis for allergic rhinitis, while some others studies could not demon- in the Trabzon city center, most frequent allergic reactions were strate any difference between genders. In the study conducted by detected against Dermatophagoides pteronyssinus and D. farinae, by Alsowaidi et al. (13) in United Arab Emirates, it was reported known as mites. This was followed by allergies against the main that the prevalence of allergic rhinitis was higher in the female grass group and main tree group. population. In a study conducted by Van Gysel et al. (14) in Bel- gium, while allergic rhinitis was significantly higher in males in Based on logistic regression analysis, living in an apartment flat children younger than 8 years of age, a significant increase was (OR: 2.17; 95% CI: 1.16–4.05) and smoking habits of parents observed in the prevalence of allergic rhinitis in females. The time (OR: 1.93; 95% CI: 1.23–3.03) were found to be independent interval from 8 to 10 years was accepted to be significant for chil- risk factors for allergic rhinitis (Table 3). dren in the study, and the prevalence rate of allergic rhinitis evi- dently increased for females during this period. It was stated that Discussion gender and age-related changes involved the pre-pubertal period Allergic diseases are one of most studied diseases. Their patho- in females in this age group and were related to hormonal changes. physiology and etiological factors have been gradually under- As other examples in the literature, female gender was found to be stood better, which contributes to the development of novel a significant risk factor for allergic rhinitis in our study. treatment modalities. Although the prevalence of allergic rhi- nitis varies on the basis of regions, countries, and climates, its Smoking stimulates inflammatory cells of the airway. It causes prevalence rates presumably increase (5). airway inflammation by proinflammatory mediator release and 26 Çobanoğlu et al. Allergic Rhinitis Prevalence in Trabzon Turk Arch Otorhinolaryngol 2016; 54: 21-8

Table 3. Logistic regression analysis OR 95% CI (confidence interval) p value Gender Male 1 Female 1.42 1.04 –1.95 p=0.015 Room sharing Single 1 Sharing room with one or more people 1.24 0.89–1.73 p=0.197 House type Others 1 Apartment 2.17 1.16–4.05 p=0.015 Smoking habits of parents None 1 Only mother 1.34 0.93–1.91 p=0.116 Only father 1.17 0.62–2.22 p=0.634 Both parents are smokers 1.93 1.23–3.03 p=0.0024 Heating device used in the house Floor heating 1 Central system 0.84 0.57–1.25 p=0.395 Wood stove 0.69 0.41–1.17 p=0.168 Coal stove 1.15 0.74–1.81 p=0.534 Room heater (with electric) 1.08 0.39–3.00 p=0.880 Owning pets None 1 Pet owner 1.06 0.65–1.73 p=0.816 Owner of only cat /dog / bird 1.05 0.71–1.55 p=0.822 Constant: −2.93; OR: odds ratio neurologic inflammation (15). In a multi-center study conduct- nomic status because the “protective” effect of exposure to bacteria ed by Kurt et al. (16) in 17 provinces in Turkey in 2007, smoking is also eliminated (20). In our study, the socioeconomic level was was effective in respiratory tract allergies and the prevalence of not included in the questionnaire. This factor was not examined allergic rhinitis was higher in smokers. because it would not be proper and realistic to investigate the net income or education level of the family as the questionnaire survey In their study involving 6794 preschool children in Singapore, was given to children aged 12 to 15 years. Socioeconomic levels Zuraimi et al. (17) determined that smoking in the house was in the Trabzon city center, where the study was conducted, did related to the deterioration of rhinitis symptoms. On the other not vary considerably. Furthermore, the investigation would cause hand, Keil et al. (18) conducted a study on 1314 children in classification or grouping among the children in this age group Germany and reported that smoking of mothers was a risk fac- who would enter into the period of adolescence. tor only in children of allergic parents. Internal environment pollutants such as nitrogen oxides, carbon In this study, one or both parents of 52.8% of children were monoxide, and sulfur dioxide were risk factors for respiratory tract smokers. Our study showed that smoking of both parents was allergies, and it was known that the main sources for nitrogen di- a significant risk factor in terms of allergic rhinitis (p=0.004). oxide and carbon monoxide were the heating stoves and furnaces (7). When the relationship between allergic rhinitis and heating The socioeconomic level has been examined in almost all studies methods, which was accepted as a risk factor, was considered, the on allergy. The fact that the risk of allergic rhinitis was higher in incidence of allergic rhinitis in people using wood heaters (17.2%) groups with a higher socioeconomic level has been associated with was found to be higher than that in people using other types of the fact that such people express their complaints clearer and seek heating sources (13.8%). However, this difference could not be medical help more frequently (8). On the other hand, some stud- construed as being statistically significant. ies have also demonstrated that allergic rhinitis is less frequently observed in people with a low socioeconomic level and in farmers. The Trabzon Province is surrounded by high mountains from According to the compilation of Mösges from Germany, numer- the sea level toward inner areas in the Eastern Black Sea region. ous environmental risk factors in parents with higher socioeco- Trabzon is the largest city in the Black Sea Region. Geographi- nomic level were eliminated (19). Smoking is not advised during cal features, climate, and vegetation of Turkey vary considerably. pregnancy. When the family has a newborn baby in the house, it is As a natural result of this fact, the climate of every region and, not recommended to have a pet. In addition, breastfeeding should accordingly, aeroallergens vary. In the study conducted by Ayvaz not be discontinued prematurely. Although such risks are eliminat- et al. (21) regarding seasonal distribution of aeroallergens in the ed, allergic rhinitis may develop in children with a high socioeco- atmosphere of Trabzon, aeroallergens consisted of pollens of Turk Arch Otorhinolaryngol 2016; 54: 21-8 Çobanoğlu et al. Allergic Rhinitis Prevalence in Trabzon 27 trees and woody plants (59.2%) and herbaceous plants (40.8%). The findings of skin prick tests were evaluated, and the most In this study, the most frequently encountered aeroallergens ac- common allergens at Trabzon city center were specified asD. cording to the annual average were Corylus (nut) (17.9%), Poa- pteronyssinus and D. farinae, which are also known as house dusts cea (graminae) (13.6%), Pinus (pine) (7.9%), and Alnus (alder) or mites. This was followed by allergies against the main prairie (5.3%). According to the pollen calendar, in our region, pollens group and main tree group. Such values were deemed as com- were mostly encountered in June (21). patible to the values reported in the literature.

In Trabzon, where the Black Sea climate is dominant, summer is The main prairie group and main tree group were frequently cool, winter is relatively warm, and it is rainy every season (22). seen as allergens responsible for intermittent allergic rhinitis. Major differences in temperature or sharp transitions between While the studies conducted in our country had similar findings the seasons are not observed within the year. As a reflection of as our results, the clinical picture was different from that in the this, in our questionnaire, when we examined persistent allergic studies conducted in other countries. In a study of Prasad et al. rhinitis symptoms according to seasons, a statistical significance (26) in India, the most common allergens detected in the prick could not be observed between seasonal differences and symp- test study performed on 48 patients with nasobranchial allergy toms (p=0.112). We considered that this result was associated were insects, mites, and pollens, in decreasing order of frequency. with less temperature transitions between the seasons and the Conclusion absence of very dense winds or very arid climates. To our knowledge, this is the first prevalence study in this age However, when we observed the allergens according to the sea- group in Trabzon, which is the largest settlement in the Eastern sons and considered the responses of the children with allergy Black Sea Region. Our findings determined the prevalence of to questionnaire items in the main weed group and main prairie allergic rhinitis in this region to be 14.5%. For allergic rhini- group in the skin prick test results, we saw that allergens were tis, female gender, smoking habit of parents, owning pets, and more important in spring (p<0.001). living in a flat were significant potential risk factors. Sharing bedroom with one or more people, using wood burning stove as Another factor questioned for allergic rhinitis in our study was the heating system and older age of the mother at delivery were the “quality of the house.” Allergic rhinitis was diagnosed in a found to increase the likelihood of having allergic rhinitis, but significant number of students living in an apartment flat in the difference was not significant. Further research with larger comparison with those living in a house (p=0.015). This was also, sample sizes would be a promising next step to reveal the impact as specified in the study of Tomaç et al. (9) in Zonguldak and in of these risk factors on the development of allergic rhinitis. the study of Selnes et al. (11) in Norway, supported by the theo- ry that allergic rhinitis was more frequently observed in children Ethics Committee Approval: Ethics committee approval was received for this study from the ethics committee of Karadeniz Technical Uni- living in an apartment flat than in children living in a house or versity (file no:2009/36). a closed area for a long time in bigger city centers with more air pollution, termed as “West type living” (18). Informed Consent: Written informed consent was obtained from pa- tients’ parents who participated in this study. The results of studies in which allergic rhinitis and pet feeding relationship was evaluated have also demonstrated variations. In Peer-review: Externally peer-reviewed. the questionnaire study of Kalyoncu et al. (23) on 4639 univer- sity students and in the study of Gysel et al. (14) and study of Author Contributions: Concept - H.B.Ç.; Design - H.B.Ç. Super- vision - A.I.; Materials - H.B.Ç.; Data Collection and/or Processing Mösges (19), a significant relationship between pet feeding in - M.T., H.B.Ç.; Literature Search - H.B.Ç.; Writing Manuscript - the house and allergic rhinitis was observed, but in the other H.B.Ç.; Critical Review - A.U. studies conducted in our country, no such relationship was ob- served (8-10). In our study, the correlation between pet feeding Conflict of Interest: No conflict of interest was declared by the authors. in the house and allergic rhinitis was significant (p=0.04). Financial Disclosure: The authors declared that this study has re- In the literature, different results have been oberved in studies ceived no financial support. that were conducted on the age of mothers and allergic rhinitis. In the ECRHS questionnaire survey study of Laerum et al. (24) References 1. Keleş N. Alerjik rinitte medikal tedavi. 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